For juvenile orders, list the primary protected person’s information in and 3 . • If the judge grants the restraining order, information you give on this form will be entered into a California database (called CLETS) to help law enforcement enforce the order. • If information changes later, you may complete this form again and turn it in to the court. To Court Clerk: Do not file this form. The information on this form must be entered into the protective order registry in CLETS. Court fills in case number when form is received.

Case Number: Date received by court: Information that has a star (*) next to it is required. All other information is helpful. 1 Person You Want a Restraining Order Against *Name: Other names used: Marks, scars, or tattoos: SSN:Driver’s license (number and state): Vehicle type: Model: Year: Plate number: Name of employer and address: Does the person speak English? Yes I don’t know No (list language): Does the person have any firearms (guns), firearm parts, ammunition, or body armor?

No I don’t know Yes (Give any information you have below, like the type, amount, or location of any items, if known.) Telephone: This is not a Court Order—Do not place in court file. For your protection and privacy, please press the Clear button after you have printed the form. Confidential Information for Law EnforcementRev.

January 1, 2026 CLETS-001, (Skip and if you are asking for a gun violence (form GV-100) or retail crime (form RT-100) restraining order.)3 Your Information *Age: Date of Birth (month, day, year): (If the judge grants your restraining order, your information will be entered into California’s law enforcement database. If you give your date of birth, it will also be entered into the federal law enforcement database.

If your information is not in the federal law enforcement database, your restraining order may be more difficult to enforce outside of California.) 4 Other People You Want Protected *Name: *Gender: Race: Date of Birth: *Name: *Gender: Race: Date of Birth: *Name: *Gender: Race: Date of Birth: *Name: *Gender: Race: Date of Birth: Check here if you have more people to list. Write them on a separate piece of paper, write “Item 4” at the top, and attach it to this form. Telephone: No (list language): Do you speak English? Yes This is not a Court Order—Do not place in court file.

X (nonbinary)*Gender: M F Race: Case Number: 2 *Your Name: